I have spent much of the past two weeks with Millennials—the 18 to 34-year old’s who are a third of the U.S. work force and a voice not readily heard in healthcare.

The statistics tell a story that’s impressive (See Fact File): they’re more ethnically diverse, more technologically savvy and more educated than their predecessor generations. There are 76 million of them—a fifth have immigrant parentage and the majority have friends with a different ethnic background. They’re less partisan, less trusting of institutions, less affiliated and less hopeful about the future than prior generations and a formidable market in our economy.

In practical terms, Seniors and Baby Boomers represent bigger chunks of the $3.2 trillion healthcare pie but Millennials are the generation likely to have the most fundamental impact on its future. It’s the depth of their views that merits consideration by health professionals. It’s clear they aren’t buying what we’re selling. Here are their core beliefs:

Healthcare should be more about health and less about treating the sick. Millennials dabble in alternative health and almost a fifth come from ethnic traditions that favor non-Western methods of care. They believe the U.S. approach is more about curing than preventing, and seek balance between the two. And they are the first generation to recognize social determinants play a huge role in healthiness and mental health is not to be subordinated to physical health.

The system is no system at all. It’s a confusing hodgepodge of “stuff” that’s impossible to understand and navigate. They thrive on Amazon’s quick access and ease of transaction. They embrace their apps: they’re easy to use, convenient and user-driven. And they’re keen to keep up with cutting edge systems for procurement, forcing incumbents to constantly innovate or risk irrelevance. As a result, they see healthcare as an industry that rewards sectarianism, modest innovation and unnecessary administrative complexity.

Getting routine care is smart, but expensive. I will take my chances. Millennials take their chances with primary care and insurance plans that offer access. There is one reason: cost. Millennials are in a perpetual state of economic stress. Risking a healthcare incident is a chance worth taking, they think, especially if their employer offers a cheap catastrophic plan or their young household faces other financial pressures. Millennials understand preventive health is a smart choice, but they consider cheaper ways to get it first before exploring traditional venues. And they see the prejudice of the system toward patients who can pay and those that can’t—it’s not lost of their sense of fairness.

Doctors care more about themselves than their patients. Millennials do not worship at the feet of M Deity. They respect the profession but do not accept its invincibility. They use social media to find clinicians and share their experiences and they convey their disdain for clinicians who appear arrogant or condescending to their online friends and family.

The politicians don’t have a clue. Millennials do not understand the nuances of the current political debate about healthcare. They understand Republicans want something less accessible than Democrats. They know Republicans talk about costs and Democrats talk about coverage. But the majority are political independents and inclined to turn the dial. And they think Congress, the White House and their close-knit partisans are playing a game with their future and they don’t trust them.

Healthcare matters to us today. Millennials understand diseases that rob their health and accidents that rob families of their wellbeing. They do not wish to be seen as a future market: they see opportunity to address their needs today. But they’re confident we’re not paying attention. Otherwise, there would be no debate about extended hours, telehealth, virtual medicine et al.

Two of my sons, Josh and Jordan, are Millennials. I’ve come to know many of their friends and in traveling the country, I frequently ask their peers what they think about healthcare. Their answers are usually followed by a deep breath, a sigh followed by “seriously?”. What follows is rarely well-informed but no less relevant to the healthcare answer we need to hear.

Clearly, they’re not buying what we’re selling.

Paul

P.S. This week, Congress will take up authorization of the Children’s Health Insurance funding serving 9 million low income kids and emergency arrangements to shore up cost sharing subsidies so insurer filings this Wednesday are not a huge surprise and political embarrassment. And on the heels of Tom Price’ resignation Friday night, speculation about his successor and what that appointment will mean to alternative payment programs, Medicaid and Medicare funding, drug prices and a host of complicated issues will take center stage. My hope is the appointment will have real-world experience: a host of qualified lieutenants can capably support the role but what’s lacking is pragmatism in our leadership!

Fact file:

Physicians: 58% of millennials said they trust their physicians compared with 73% of all others. (Kanter Health) Millennials prefer retail clinics over a scheduled visit to their physician: 34% prefer retail clinics and 24% prefer acute care clinics vs. Boomers 17% to 14% and Seniors 15% to 11% (PNC Healthcare). 93% do not schedule preventive physician visits and 51% visited a primary care physician less than once per year (ZocDoc). Boomers see their primary care physician 80% of the time, while Millennials see their PCP 61% of the time (PNC Healthcare). 40% believe their primary care physicians would not recognize them if they passed them on the street (Salesforce).

Social media: 23% of Millennials say they've looked at online reviews for healthcare providers or hospitals, compared to 15% of non-Millennials (Harris Poll). Millennials have 250 friends on Face Book (Pew). 51% of millennials and Gen-Xers use online reviews to select care providers compared to 40% of baby boomers and 28% of seniors (PNC Healthcare). 50% of millennials and 52% of Gen-Xers compare insurance options online vs. 25% of seniors, who prefer print materials (48%) and in-person consultations (38%) (PNC Healthcare). 75% of Americans use social media to research their symptoms and 90% trust medical info shared on their social feeds (PwC Health Research Institute).

Technology: 71% of Millennials want to book appointments through mobile apps and 74% would prefer seeing a doctor virtually (Salesforce). Millennials are the most likely to be interested in telehealth (74%) vs. 70% of individuals between 35 and 44, 64% between 45 and 64 and 41% of individuals age 65 and above (Harris Poll).

Costs: 54% of Millennials have delayed or avoided medical treatment due to costs vs. 37% of Boomers and 18% of seniors (PNC Healthcare). 41% of Millennials say they request and receive estimates before undergoing medical treatment vs. 18% of seniors and 21% of boomers (Fair Health). 50% of Millennials avoid seeing the doctor to save money prioritizing their bank account over the state of their health (Becker’s Hospital Review).